急性磷酸盐肾病的临床病理特征及预后

Clinicopathological features and prognosis of acute phosphate nephropathy

目的:探讨口服磷酸钠盐导致的急性磷酸盐肾病(APN)患者的临床病理特征及预后。方法:回顾分析2010年1月至2022年11月国家肾脏疾病临床医学研究中心行肾活检诊断为APN的患者,分析其临床表现、病理特点、治疗及预后。结果:共纳入APN患者9例,其中男性7例,肾活检时年龄60.1±9.1岁。患者均因需行结肠镜检查口服磷酸钠盐,服药前血清肌酐(SCr)水平均在正常范围,1例无高危因素,其余8例存在2~4种高危因素(中位3种)。诊断急性肾损伤(AKI)时,SCr为257.24±63.65μmol/L;除1例血磷升高,余患者血钙、血磷水平均在正常范围。尿检无红细胞,仅2例出现少量蛋白尿。肾活检光镜下主要表现为肾小管间质损伤,肾小管上皮细胞、管腔和间质中均观察到多处偏振光无折光性的嗜碱性钙盐沉积(全片共25~58处)。6例患者接受泼尼松(15~30 mg/d)治疗。中位随访14月,7例患者肾功能改善,但SCr均未恢复至正常范围,末次随访SCr为175.92±45.05μmol/L,估算的肾小球滤过率(e GFR)为36.33±12.83 m L/(min·1.73m^(2))。结论:口服磷酸钠盐导致的APN通常起病较为隐匿,肾活检有助于明确诊断。对于存在高危因素的患者应慎用磷酸盐洗肠液,并密切监测肾功能变化,以提早识别和处理。

Objective:To investigate clinicopathological features and prognosis of patients with acute phosphate nephropathy(APN)caused by oral sodium phosphate salts.Methodology:We retrospectively analyzed patients diagnosed with APN by renal biopsy at the National Clinical Research Center of Kidney Diseases,Jinling Hospital from January 2010to November 2022,and analyzed their clinical manifestations,pathological features,treatment and prognosis.Results:A total of 9 patients with APN,including 7 males,aged 60.11±9.14 years at the time of renal biopsy,were included.The patients were all taking oral sodium phosphate for the need of colonoscopy,and the serum creatinine(SCr)levels were in the normal range,but with a median presence of 3 high-risk factors.At the time of diagnosis of acute kidney injury(AKI),SCr was 257.24±63.65μmol/L;except for one case with elevated blood phosphorus,the rest of the patients had normal blood calcium and phosphorus.Urinalysis was free of erythrocytes,and only 2 cases showed a small amount of proteinuria.Six patients were treated with prednisone(15~30 mg/d).At a median follow-up of 14 months,renal function improved in7 patients,but none of the SCr returned to the normal range.SCr at the last follow-up was 175.92±45.05μmol/L and the mean e GFR was 36.33±12.83 ml/(min·1.73 m^(2)).Conclusion:APN due to oral sodium phosphate salts usually has an insidious onset,and renal biopsy can help clarify the diagnosis.Phosphate lavage should be used with caution in patients with high-risk factors,and changes in renal function should be monitored closely for early recognition and management.